The opioid epidemic has hit the United States with great force for many decades now. It is due to the increasing prescription of prescription opioids to pain patients. More than one million people have died from drug overdoses, most of them due to opioids, since the year 2000. The number of overdose deaths due to prescription opioids is also increasing in Norway. Paralgin forte and Oxycontin are examples of prescription opioids. – These medicines can be prescribed by a doctor or they can be obtained from the illegal market, says professor with UiO and researcher at the Norwegian Institute of Public Health, FHI, Svetlana Skurtveit. Read also: Reacting to the labeling of the “Dopesick” medicine in Norway Svetlana Skurtveit, together with other researchers, has looked at what characterizes those who die from an overdose of prescription drugs in Norway, with those who die from an overdose due to, for example, heroin. Photo: Private 1,224 people died from prescription opioids Norway ranks higher than the other Scandinavian countries when it comes to prescribing prescription opioids. In 2020, 555,000 people, about 10 per cent of the population, were prescribed pain-relieving opioids. In particular, there is an increase in the use of the pain medication oxycodone, which is responsible for the increase. In 2020, 63,000 Norwegians were prescribed oxycodone. Oxycodone is the active ingredient in the medicine OxyContin. – At the same time, the number of overdoses of prescription pain medication has increased, and since 2016, strong painkillers have been the most common cause of overdose deaths in Norway, according to Svetlana Skurtveit. Together with other researchers, she has looked at what characterizes those who die from an overdose of prescription drugs in Norway, with those who die from an overdose due to, for example, heroin. The study from FHI and UiO is based on data from the central health register in Norway, and is part of a project funded by the Research Council whose topic is how we can avoid an opioid epidemic in Norway. Demonstrations against the “Dopesick” drug OxyContin, and the company behind it called PurduePharma. Photo: Carolyn Kaster / AP By examining causes of death from 2010 to 2019 for the entire population, the researchers concluded that 1,224 people died from overdoses of prescription opioids, and 1,432 people died from overdoses of other drugs, such as heroin. Facts about opioids for medical use Below is a list of opioids that are used in medical treatment. The list is arranged alphabetically by the name of the ingredient. The trade names of the preparations that are sold in Norway are in brackets. Alfentanil (Alfentanil, Rapifen) is a strong opioid that is available as an injection solution and is used in connection with short-term anesthesia. Buprenorphine (Temgesic, Subutex, Suboxone, Norspan, Bugnanto, Bunalict, Buprefarm, Buprenorphine, Buvidal) is a strong opioid. The substance is mainly used in the treatment of opioid addiction in drug-assisted rehabilitation (LAR), but can also be used to treat severe pain. Buprenorphine is available as tablets that are placed under the tongue, as a plaster and as an injection. Ethylmorphine (Cosylan, Solvipect comp) is given as an oral solution and mainly has a host-inducing effect, but also has a certain sedating effect and, like the other opioids, can cause intoxication. Ethylmorphine is partially converted to morphine in the body. Fentanyl (Abstral, Durogesic, Fentanyl, Instanyl, Leptanal, PecFent) is a strong opioid that is available as an injection, tablets to place under the tongue, patches and nasal spray. Fentanyl is mainly used in connection with anaesthesia, and for severe long-term pain, as well as as pain relief for severe breakthrough pain in patients who are already on maintenance treatment with other opioids. Hydromorphone (Hydofon, Palladon) is a strong opioid. It is available as an injection and is used for severe pain. Ketobemidone (Ketorax, Ketogan) is a strong opioid that is available as tablets, suppositories and injection liquid and is used for severe pain. Codeine (Altermol, Codeine, Paralgin forte, Paralgin Major, Pinex Forte, Pinex Major, Paramax Comp) is a weak opioid that is used for moderate to severe pain. It is available as tablets and suppositories, often in combination with paracetamol. Methadone is a strong opioid that is used as a substitution treatment for opioid addiction and for severe pain. Methadone is available as oral solution and tablets. Morphine (Morphine, Morphine, Dolcontin, Malfin, Oramorph, Dropizol) is a strong opioid. Morphine is given as tablets, oral solution, drops or as an injection, and is mainly used in the treatment of severe pain. Oxycodone (OxyContin, OxyNorm, Targiniq, Oxycodone, Reltebon Depot, Targin) is a strong opioid that is available as tablets, capsules, oral solution and for injection, and is used for severe pain. Pethidine (Pethidine) is a strong opioid that is available as suppositories and for injection, and which is used for severe pain. Remifentanil (Ultiva) is a strong opioid that is available as an injection and is used in connection with anaesthesia. Sufentailn (Sufenta) is available as an injection solution and is used in connection with anesthesia and epidural pain relief in hospitals. Tapentadol (Palexia, Palexia depot) is a strong opioid available as tablets and prolonged-release tablets for the relief of moderate to severe acute pain. Tramadol (Tramadol, Nobligan, Tramagetic OD, Tramagetic Retard, Trampalgin) is a weak opioid that is used to treat moderate to severe pain. It is available as tablets and capsules, possibly in combination with paracetamol. Source: OUS – We have a new group of patients who die from overdoses What distinguished the two groups with overdose deaths? – The findings show that we have a new group of patients who die from overdoses, which until now has not been identified as a group at risk of overdoses, says Svetlana Skurtveit. These are the most important findings of the new study: *Those who died of overdose with prescription opioids were older, and more often women, than the other group of overdose deaths. * This group also had a higher incidence of chronic pain and cancer. * The group who died from prescription opioids had more often been prescribed this by a doctor a month before they died, than the other group with overdose deaths. The difference was 38 percent versus 12 percent. *The group who died from prescription opioids used three times as much opioids prescribed by their doctor as the other group with overdose deaths. *In the group that died from prescription opioids, oxycodone and fentanyl were the most common pills prescribed, while codeine was most common in the other group. *Those who died from prescription opioids had less frequent mental disorders, or a previously known history of abuse, than in the other group. – Our conclusion is that those who die of overdose due to prescription pain medication are often older, they are often women with chronic pain, and they use large doses of pain medication, says Svetlana Skurtveit to news. – This group may have to be approached with a different strategy than the traditional overdose strategy, which is aimed more at users of illegal drugs such as heroin, says Skurtveit. – Is this a group of patients who go under the radar? – The patient group falls outside of traditional measures that target more those who are dependent on illegal substances such as heroin, says Skurtveit. Also read: I’m the one who hears her crying at night Opioids are a type of powerful painkiller that is addictive. In the US, there have been a number of large lawsuits against pharmaceutical companies that have produced the pills. This is a box with the active substance Oxycodone, which is sold under the name OxyContin, among other things. Photo: Mark Lennihan / AP – The findings should be given importance Skurtveit says it is now important for doctors to find out about this new risk group before things go wrong. – Perhaps the most important thing is that doctors become aware that this patient group exists and thereby also become somewhat more aware of their own practice and perhaps involve other parts of the healthcare system to a greater extent, says Skurtveit. The study shows that many in this patient group have been prescribed prescription opioids by their doctor. The question is whether the doctors have too little control, or too little awareness. – No, the most important thing is probably that you gain more knowledge that patients who have been prescribed opioids can also be at risk of overdoses. If this becomes better known, it will probably lead to more attention to such prescribing, Skurtveit believes. The Medical Association: – we must be extra vigilant in the use of opioids The Medical Association believes the study is interesting and important, says Ståle Onsgård Sagabråten, Specialist in general medicine and head of the board of the Norwegian Medical Association. He says the Norwegian professional community has been keen not to get a situation similar to that in the USA, where the use of opioids has increased sharply for long-term non-cancer-related pain, and where this has led to a violent overdose epidemic. – Although Norwegian doctors are generally aware of this, the study shows that we must be extra vigilant in the use of opioids for chronic pain conditions, but also in connection with cancer. The study indicates that we in Norway are slightly higher than other Scandinavian countries in prescribing such drugs, we need to look more closely at the reasons for this, says Onsgård Sagabråten. The Medical Association believes the study is interesting and important, says Ståle Onsgård Sagabråten, Specialist in general medicine and head of the board of the Norwegian Medical Association. Photo: Legeforeningen He believes the study from FHI shows that we need more research into how chronic non-cancer-related pain can be treated in a good and safe way. – But already this work from FHI reminds us that we need to be extra vigilant in treating pain in the elderly and women with chronic pain. It is important that a thorough pain analysis is carried out before starting and that plans are made for follow-up so that these patients are followed closely, says Onsgård Sagabråten. The pharmaceutical company Mundipharma, which produces the pain medication OxyContin for the Norwegian market, has been given the opportunity to respond to the content of this article. They have not responded to news’s inquiry.
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A new patient group dies from overdoses – news Norway – Overview of news from various parts of the country
